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This brief provides actionable steps for state health departments to reduce administrative hurdles in grant management for local health departments.

North Carolina’s Recovery from Hurricane Ian North Carolina’s Recovery from Hurricane Ian Emma Talkington, Nick Porter Learn how North Carolina leveraged ASTHO resources in their hurricane recovery work in this brief. Hurricane preparedness, response, and recovery work continues to be a top priority for state and territorial health departments. Damaging winds, historic storm surge, and intense rainfall pose severe risks to those caught in the path of these formidable storms, and the impacts can be felt for far longer than the immediate hazards. In 2022, Hurricanes Ian, Fiona, and Nicole made landfall in the United States, causing dozens of deaths and billions of dollars in damage. Hurricane Ian alone caused 66 direct and 90 indirect deaths. In late 2023, and again in late 2024, CDC awarded funding from the FY23 Omnibus Disaster Supplemental to ASTHO to assist North Carolina in building capacity to recover from the environmental health impacts brought on by Hurricane Ian and to respond to future hurricanes. ASTHO worked closely with staff from CDC’s National Center for Environmental Health/Agency for Toxic Substances and Disease Registry (NCEH/ATSDR) Office of the Director and staff from the North Carolina Department of Health and Human Services (NCDHHS) to implement capacity building projects to bolster environmental health preparedness, response, and recovery capabilities identified as gaps following Hurricane Ian. Identifying Gaps and Needs from Hurricane Ian NCDHHS focused on building out their environmental health preparedness, response, and recovery program capacity by creating needed communication materials on disaster-related environmental health topics, developing training and exercise materials, and sharing this information with partners and the public. They noted these activities are difficult to complete with competing priorities and a lack of dedicated staff and identified them as needs following Hurricane Ian. The support from NCEH/ATSDR and ASTHO provided NCDHHS with the resources needed to complete this work. Updating Communications and Training Materials The primary focus during NCDHHS’s first year of this project was updating communication and training materials, particularly around environmental health issues associated with hurricanes. With existing staff in the Environmental Health Section and two additional temporary staff, NCDHHS separated the activities into two categories: training/exercise preparation, and emergency preparedness communication preparation. Staff developed training materials, after action reporting policies, and topic-specific communication resources (childcare in shelters, norovirus outbreaks, donated food, etc.). Utilizing Capacity Building Efforts from Hurricane Ian to Assist with Hurricane Helene Response Ahead of the second year of this work, North Carolina was heavily impacted by Hurricane Helene in September 2025. As a result, NCDHHS largely focused on responding to and recovering from the impacts of the hurricane. The ASTHO and NCEH/ATSDR supported capacity building efforts related to Hurricane Ian recovery allowed NCDHHS to work through issues such as when to reopen public parks after major flooding, the identification of resources for homeowners on mold assessments, and providing guidance on mudslides and slope destabilization after hurricanes. Developing Training and Resource Materials for Drinking Water Emergencies Once NCDHHS transitioned resources back to this project, they expressed a need to conduct training focused on drinking water emergencies, a gap identified following Hurricanes Ian and Helene. In response to this need, NCDHHS developed several guidance documents for local health departments and food establishments during a water emergency, with assistance provided by their two temporary staff members. Several of those resources, as well as other newly developed and updated resources as a part of this project, can be found on their new Emergency Preparedness and Response webpage. NCDHHS and the temporary staff also developed and executed a water emergency tabletop exercise with local health department staff in April 2025. For more information on these efforts, please refer to the June 2026 edition of the Journal of Environmental Health publication on the topic. Developing and Launching the Community Meals Food Safety Training Another training priority identified by NCDHHS included the need for a curriculum targeted towards individuals and groups interested in hosting free or reduced cost meal events after a hurricane. The curriculum would provide actionable food safety knowledge and principles to these groups to help prevent foodborne disease outbreaks after a disaster. ASTHO worked with NCDHHS staff and North Carolina State University’s Safe Plates Program to develop a plain language training curriculum that covered these topics. The Community Meals Food Safety Training resulted from this collaboration and includes food safety resources for community groups in both English and Spanish. The first training was provided in June 2025, and as of June 2026 it has been provided eight times and has been well received by trainees based on participant evaluations. Just-in-time training is also available, with a recorded version of the course posted to the course website. Procuring Supplies and Identifying Printing Needs to Address Response Gaps During the final year of the project, NCDHHS primarily focused on continuing to provide and promote the Community Meals Food Safety Training to communities across the state. They also developed handouts to supplement the information provided in the training, focusing on topics such as food service in disasters, meal events in temporary facilities, and water safety. ASTHO supported the printing of materials associated with the training, as well as travel funding for NCDHHS staff to attend the Council of State and Territorial Epidemiologists Annual Conference in June 2026 to present on these community training efforts. NCDHHS also requested a short list of supplies that would assist them in conducting shelter assessments and staying connected in the field during response activities. ASTHO provided these supplies using funds associated with this project. Conclusion Support provided from ASTHO and NCEH/ATSDR allowed NCDHHS to build capacity in key environmental health preparedness topic areas, including food safety, drinking water safety, and shelter assessments, among other topics. Moving forward, the Community Meals Food Safety Training curriculum will be utilized to train the trainer and assist in the prevention of foodborne disease outbreaks following hurricanes. Other resources developed will help both NCDHHS and the public prepare for and respond to hurricane-linked environmental health hazards. Acknowledgements Thank you to the staff within NCDHHS that worked tirelessly to implement this project, including the temporary staff. Thank you also to CDC’s NCEH/ATSDR staff who oversaw this project. Without their support, none of this work would have been possible. Hurricane Response Recovery - NC, SC article yes

How Puerto Rico Leveraged Data in Recovery from Hurricane Fiona How Puerto Rico Leveraged Data in Recovery from Hurricane Fiona Emma Talkington, Nicholas Porter Learn how ASTHO provided resources for Puerto Rico's hurricane response and recovery program. Hurricane preparedness, response, and recovery work continues to be a top priority for state and territorial health departments. Damaging winds, historic storm surge, and intense rainfall pose severe risks to those caught in the path of these formidable storms, and the impacts can be felt for far longer than the immediate hazards. In 2022, Hurricanes Ian, Fiona, and Nicole made landfall in the United States, causing dozens of deaths and billions of dollars in damage. Hurricane Fiona alone caused seven direct and 22 indirect deaths. In late 2023, and again in late 2024, CDC awarded funding from the FY23 Omnibus Disaster Supplemental to ASTHO to assist Puerto Rico in building capacity to recover from the environmental health impacts brought on by Hurricane Fiona and to better respond to future hurricanes. ASTHO worked closely with staff from CDC’s National Center for Environmental Health/Agency for Toxic Substances and Disease Registry (NCEH/ATSDR) Office of the Director and staff from the Puerto Rico Department of Health (PRDOH) to implement capacity building projects to bolster environmental health preparedness, response, and recovery capabilities identified as gaps following Hurricane Fiona. Identifying Gaps and Needs from Hurricane Fiona PRDOH strategically leveraged NCEH/ATSDR and ASTHO support to launch a foundational data modernization initiative designed to strengthen hurricane preparedness and response capabilities across multiple environmental health programs. This initiative directly addressed a key need communicated by PRDOH to ASTHO and NCEH/ATSDR in the wake of Hurricane Fiona: modernize data collection and storage processes to facilitate faster data queries and improved data sharing before, during, and after hurricanes. Digitizing Inspection Forms Rather than pursue isolated technology improvements within individual service areas, PRDOH intentionally selected its Radiological Health Section as a pilot program to develop and test a scalable digital infrastructure that could ultimately be expanded across their environmental health portfolio. PRDOH staff first analyzed the needs of their Radiological Health Section and worked with their five ASTHO-supported temporary staff to digitize various inspection forms for the Section within REDCap to allow inspectors to collect data via a tablet computer instead of paper forms. This change would allow for rapid data queries during emergencies that support decision making and data sharing among key partners. PRDOH and the temporary staff also utilized GIS software to create an interactive map that integrates geospatial data from the Radiological Health Section’s inspections, allowing for better response planning and inspection prioritization for future storms. The success of the Radiological Health Section work formed the basis of a broader effort within PRDOH’s Environmental Health Division. By establishing common tools, workflows, and data management practices, PRDOH created a framework that could be adapted to other environmental health programs. This work continued into the second year of the project with staff focusing on digitizing inspection forms for the Vector Control Section, further advancing PRDOH’s vision of an integrated, data-driven approach to environmental health preparedness, response, and recovery. This work proved timely as PRDOH responded to a major dengue outbreak that began in 2024 and continued through 2025. For the second year of support, PRDOH was interested in hiring additional temporary staff to help support their Vector Control Section work as only two remained after the first year. However, due to the short timeline listed in the job postings, ASTHO and their staffing support partner were unable to identify any additional temporary staff who were qualified and willing to take on the short-term role. Utilizing REDCap Technical Expertise The two remaining temporary staff expressed interest in receiving technical support within REDCap. ASTHO identified a REDCap technical expert from the Tennessee Department of Health who could offer guidance on using the platform and answer any questions. ASTHO organized two technical assistance calls between the REDCap expert and PRDOH to discuss questions, share best practices, and provide guidance on utilizing REDCap for their data modernization work. The questions were technical in nature and included inquiries about survey auto-save functionality, integration with other applications, and language translation issues. The calls included interpreters who ensured questions and responses were provided in both English and Spanish to facilitate understanding between all involved parties. The REDCap support, along with the remaining temporary staff support, allowed PRDOH to complete their work in digitizing inspection forms for the Vector Control Section in the second year of this project. The two temporary staff transitioned to contract staff within PRDOH and were able to continue working during the third year of this project. They focused on digitizing their Milk Hygiene inspection forms for the Food Safety Section. Developing and Hosting a Food Safety Training for PRDOH Staff During the third and final year of support, PRDOH’s Environmental Health Division identified the need to strengthen the emergency response capacities of its food safety workforce. Recognizing that inspectors required targeted training and practical tools for disaster scenarios, the Division communicated this need to ASTHO, who in turn undertook the task of identifying subject matter experts in food safety emergency response. As a result, PRDOH hosted a food safety training, ER310: Food Safety Issues in the Event of Disasters: A Practical Application, in San Juan in June 2026. Over the course of the two-day training, 31 environmental health professionals from across all regional offices, including directors, supervisors, inspectors, and management staff were educated on the unique food safety hazards that occur post-disaster and were better prepared to conduct post-hurricane investigations of food facilities. ASTHO worked closely with subject matter experts from the University of Tennessee’s Center for Agriculture and Food Security and Preparedness to update and adapt the training for PRDOH’s needs. A key requirement for the training was that all materials be updated to conform with the most recent edition of the U.S. FDA’s Food Code. All course content was translated into Spanish, and the in-person component was delivered in Spanish using simultaneous interpretation services. ASTHO also worked to procure supplies needed by PRDOH to assist in future hurricane preparedness and response efforts. Conclusion The work described above developed a solid foundation for additional data modernization work within PRDOH’s Environmental Health Division. By transitioning to a modern digital data collection and storage process, PRDOH’s Environmental Health Division will be better prepared to respond to requests for information from partners, prioritize critical facility assessments after a storm, and provide important information to hurricane-impacted communities. Additionally, PRDOH will be ready to provide critical food safety support to individuals and businesses before and after a storm. Acknowledgements Thank you to the staff within PRDOH that worked tirelessly to implement this project, including the temporary staff. Thank you also to CDC’s NCEH/ATSDR staff who oversaw this project. Without their support, none of this work would have been possible. Hurricane Response Recovery - FL, PR article yes

Examine key lessons and strategies for advancing policies that prevent adverse childhood experiences and promote child well-being.

Strengthening Long-Term Care Capacity in Island Jurisdictions Through Policy Using Policy to Strengthen Islands' Long-Term Care Capacity Lana McKinney Explore policy levers island jurisdictions can use to strengthen long-term care capacity like payment flexibilities, workforce, and collaborative partnerships. Acute care facilities in U.S. territories and freely associated states experience significant strains on capacity, driven by: Difficulty transitioning medically stable patients to the next appropriate level of care. Insufficient staff to meet patient needs. Limited transitional or extended care facilities. This creates a bottleneck that compromises the efficiency and stability of health systems. However, there are policy levers available to island jurisdictions that can support appropriate care for patients requiring institutional or home-based services and supports. These include payment flexibilities, workforce initiatives, and collaborative partnerships. Current State Infrastructure Island jurisdictions have limited hospital and long-term care (LTC) facility capacity. While many have government-run hospitals, three jurisdictions — American Samoa, the Commonwealth of the Northern Mariana Islands (CNMI), and Palau — have only one hospital, the Federated States of Micronesia has one hospital per state, and the Republic of the Marshall Islands and the U.S. Virgin Islands (USVI) each operate one hospital in both of their most populous islands. Additionally, Guam has just one Medicare-certified skilled nursing facility with 40 Medicare beds, operated by the Guam Memorial Hospital Authority, while Puerto Rico has nine Medicare-certified nursing homes for a population of more than three million people. Without LTC facility capacity, hospitals lack appropriate options for discharge. Geographic isolation, difficulties with recruitment and retention of sufficiently skilled staff (i.e., nursing staff), and supply chain challenges are additional obstacles to establishing and maintaining LTC capacity. Reimbursement Federal health care programs also influence the availability of LTC services in the territories. Medicare and Medicaid may cover LTC services under different circumstances; however, federal funding restrictions limit Medicaid in the territories compared to the states. Unlike the annually calculated, income-based Federal Medical Assistance Percentage (FMAP) for states, the territories have a fixed FMAP. The current permanent FMAP for American Samoa, Guam, CNMI, and USVI is 83%, while Puerto Rico’s is 76% through FY2027. Medicaid funding for the territories also operates under a statutory cap allotment, meaning once the federal allotment is exhausted, the territory must cover all subsequent service costs with local funds. This frequently results in territories expending federal funding mid-year, which leads to service restrictions for residents and financial instability for providers. Finally, while the territories have additional financing restrictions, CNMI and American Samoa are able to operate their Medicaid programs under a special waiver authority. Policy Strategies A number of policy strategies may limit the strain on acute care facilities, address LTC needs, and support the provision of appropriate levels of care in island jurisdictions: Workforce Development Recruitment and retention of health care workers is a challenge in island jurisdictions, but public health and rural health care workforce strategies may help address staffing needs and capacity. Encourage employers and educational institutions to partner with local colleges, vocational schools, and community centers to develop apprenticeship programs and formal career pathways that support skills development, professional advancement, and patient and community needs. Identify available educational programs across the region to support a pipeline for students entering medical, nursing, pharmacy, and behavioral health careers. Promote and support dedicated in person recruitment opportunities as well as broader strategies that support local candidates and students. Develop cross-jurisdictional workforce agreements that allow training completed in one island jurisdiction to be recognized in another. Explore workforce training opportunities through commissions (e.g., Western Interstate Commission for Higher Education), universities (e.g., the Pacific Islands Geriatric Workforce Enhancement Program), and public health associations (e.g., Equipping Community Health Workers to Address Alzheimer’s) as well as curriculum exchange and workgroups (e.g., USAPI Health Workforce Development Technical Working Group). Support partnerships among island jurisdictions to share resources and learnings related to facility development, financial models, and reimbursement strategies. For public employers, decentralize HR functions to create a more efficient hiring process. For jurisdictions with professional schools and programs, develop additional training models (i.e., short-term or extended rural placements) or blended learning. Medicaid and Other Federal Health Programs U.S. territories can also consider Medicaid policies that encourage community supports over institutional care or pursue other program flexibilities through waivers or state plan amendments. For example, states and territories can provide Home and Community-Based Services and use different authorities to achieve their policy goals. Implementing a Section 1115 demonstration allows for significant flexibility but must be budget neutral. In addition, the Money Follows the Person demonstration supports community-based services over institutional care. CMS awarded time-limited planning grants to Puerto Rico and American Samoa for this initiative. Additionally, the Program of All-Inclusive Care for the Elderly helps older adults remain at home and offers comprehensive medical and social services to eligible individuals. Supported Care Transitions Several models support patients moving from hospital to home to control chronic conditions, limit readmissions and emergency department visits, reduce costs, and improve outcomes overall. This includes the Care Transitions Intervention, a short-term training program for patients and caregivers to navigate the move home. The coach’s credentials are flexible and can include nurses, social workers, community health workers, or other professionals. Meanwhile, the Transitional Care Model, provides ongoing care management and is led by an advanced practice nurse. Collaboration Strategic partnerships can drive policies that support healthy aging or aging in place. For example, USVI established a commission on aging, while Guam enacted a senior citizens housing task force, both with multi-sector representation. And in December 2025, American Samoa’s Governor issued an Executive Order establishing a Home and Community-Based Services Commission as part of its Money Follows the Person plan, which includes representatives from a number of governmental agencies and areas of expertise. Legislation Island legislatures have also explored strategies that support older adults and those with complex health care needs and their families: Guam (No. 31-38 (COR)) would establish a regulatory framework for assisted living facilities with the goal of facilitating their development and operation. In 2023, USVI 35-0119 authorized mobile integrated health programs to leverage health care personnel for in-home services and prevent costly hospital readmissions. CNMI considered a resolution to explore several policy strategies, including leveraging Medicaid flexibilities, and prioritizing collaboration and financial support to meet the needs of elderly residents. In 2026, Puerto Rico enacted legislation to improve access to information about the benefits and services available to older adults. Reviewed by - Baker-White, Kearly, Sands Leavitt, Wheatley article yes

Applying Healthy Aging Practices and Policies to Advance Brain Health and Caregiving Advancing Brain Health & Caregiving with Healthy Aging Practices Kellie Waugh, Tyrone Bethune Learn how to advance brain health and caregiving through healthy aging practices and policies, including paid family leave, healthy community design, and more. Public health departments nationwide are implementing policies, interventions, and partnerships to support health throughout the life course. Actions across ASTHO’s five Healthy Aging and Older Adult Health Technical Package objectives also serve as pathways for supporting brain health and caregiving at the state level. Consider using the following objectives, resources, and examples as you work for positive change in your jurisdiction. 1. Expand Paid Family and Sick Leave Paid leave policies support working caregivers in maintaining their economic well-being while providing care, including for those living with dementia. Inclusive leave policies help reduce employment-related stress among caregivers and allow greater focus on caring for their loved ones as well as themselves. Health departments may influence the development of flexible paid family and sick leave policies that support caregiving responsibilities, and provide evidence of the positive economic, physical, and mental health benefits. Additionally, health agencies can collaborate with multi-sector partners (i.e., labor and workforce agencies, aging services, health care providers, caregiver coalitions, and community organizations) to develop, share, and promote strategies that better support working caregivers through: Resources like those from Minnesota’s Board on Aging. Toolkits (e.g., Massachusetts Employer Toolkit to Support Working Caregivers). Public education efforts (e.g., New York’s working caregivers’ initiative). 2. Support Healthy Community Design Designing communities for lifelong health helps individuals navigate streets and community spaces, prevents chronic disease and injury, and keeps people socially connected. These measures make it easier for people of all ages to thrive, and especially support those living with Alzheimer’s Disease and Related Dementias (ADRD) and their caregivers. Public health champions have the skills and data needed to apply built environment core competencies, actively participate in planning discussions, and identify and address community needs. Transportation policies promote physical activity and reduce environmental pollutants, which support chronic disease prevention and dementia risk reduction. Similarly, efforts for affordable and adaptable housing assist individuals living with ADRD and their caregivers to safely live and age in place. Public health can: Increase awareness of the link between housing and health. Influence policies for affordable housing development and universal design. Embed safety assessments into existing home-based programming. Together, accessible communities, safe housing, and reliable transportation ensure access to essential care and services that support independence for people living with ADRD and their caregivers. 3. Promote Fall Prevention and Mobility Among the older adult population, those living with ADRD may experience higher risk for falls. Jurisdictions are strengthening policies and engaging partners in coalitions to prevent falls among older adults. These collaborative networks bring together organizations, multi-sector champions, and community members to address falls through coordinated strategies and shared resources. Fall prevention coalitions align public health, health care, and community-based efforts, and translate evidence-based strategies into sustainable action. With these coalitions, health agencies strengthen community-clinical linkages, elevate falls prevention as a public health priority, and identify initiatives that intersect brain health and caregiving. ASTHO’s guide for expanding falls prevention outlines how health departments can implement CDC’s Stopping Elderly Accidents, Deaths & Injuries framework by enhancing surveillance, care coordination, and community-based pathways to assess risk and prevent falls among older adults. These efforts reinforce the aging in place movement, providing older adults and caregivers with the necessary tools to live independently. 4. Increase Telehealth Access Expanding telehealth services is a key public health approach to improve access to care, especially for people living with ADRD and in rural communities. Telehealth services facilitate early brain health assessment and remote monitoring of chronic conditions such as ADRD, while reducing isolation among those living with dementia and their caregivers. Ensuring access to telehealth services for urban and rural communities often depends on Medicaid reimbursement. Public health can partner with state Medicaid programs to strengthen coverage for telehealth services, and health agencies may also be able to support provider regulation or related policies that improve telehealth access in the state. Additionally, data collected or utilized by health departments can shed light on the communities and programs that may benefit from having a virtual care component. Public health is focusing on patient and provider education as another avenue to increase telehealth access. Collaboration with academic medical centers, state Medicaid programs, and reliable internet providers are all promising opportunities to leverage digital care technologies. Health agencies can support provider workforce strategies (e.g., Project ECHO) to equip professionals with dementia-specific training, especially in areas that are rural or have a shortage of providers. And they should continue to monitor the evolving state and federal policy landscape to identify changes related to telehealth access and minimize potential barriers to care. 5. Strengthen the Health Care, Long-Term Care, and Public Health Workforce Public health encourages workforce readiness to support healthy aging, ADRD, and caregivers. The National Healthy Brain Initiative State and Local Road Map’s Workforce domain is a key pillar for advancing brain health and reducing dementia risk at scale. In 2025, 32 health departments reported working on at least one Workforce domain action. Agency-led activities such as training, technical assistance, and capacity building equip cross-sector professionals with evidence-based implementation strategies. Trust for America's Health has established the Age-Friendly Public Health Systems Recognition Program recognizing public health agencies for advancing workforce capacity and system-level improvements that naturally address the intersection between brain health. To date, six state health departments have achieved recognition, and Tennessee was the first to earn it across the state health agency and every local health department. Visit ASTHO’s Healthy Aging and Brain Health webpage for additional resources, and reach out to healthyaging@astho.org for technical assistance requests. article yes

Learn how public health agencies and pharmacy stakeholders can support pharmacies as contraception access hubs through policy, outreach, and more.

Creating an Informatics Job Classification Series for Health Departments Creating an Informatics Job Classification Series for Health Departments Ari Whiteman Learn why public health informatics jobs are critical for health departments in this brief. Why a Public Health Informatics Job Classification Matters The push to modernize public health data infrastructure has highlighted that traditional job classifications (e.g., Epidemiologist, IT Specialist, or Developer) do not fully capture the unique skill set and value of public health informaticians. Informatics professionals specialize in integrating, standardizing, and managing health data systems to ensure interoperability across platforms and agencies. Their expertise includes health data standards (e.g., HL7, FHIR, LOINC, USCDI), database management, extract-transform-load (ETL) processes, business intelligence tools, and cross-system data exchange, all of which are skills and proficiencies needed for data modernization transitions and processes. According to the 2022 ASTHO Profile of State and Territorial Public Health, 25 states and territories did not have a dedicated public health informatics job classification series, which would create several key advantages over forcing informaticians into traditional public health classifications that may not adequately reflect their job duties or the expertise needed to perform them: Recruitment: Public health informatics job descriptions are likely to attract more qualified and better-fit candidates for the responsibilities of the role, which differ from that of IT professionals or epidemiologists. Retention: Informaticians often leave for the private sector due to higher pay opportunities, as governmental roles often pay less than similar roles in the private sector. A well-defined classification series with competitive salary benchmarks helps retain talent. Role Clarity: Differentiating informaticians from epidemiologists or IT ensures staff are linked to projects that fit their skills and experience, which can improve performance and morale across disciplines. Future-Readiness: Quality health data infrastructure is a preparedness necessity. Informatics positions enable agencies to respond to emerging health crises by linking response and surveillance data with other state and national reporting systems. Common Challenges and Solutions Anticipating challenges can help maintain progress and understanding across all involved parties. Challenge: Resistance to creating new classifications. Solution: Propose consolidation or sunsetting of outdated roles and highlight national best practices. Challenge: Salary constraints compared to private sector. Solution: Emphasize total rewards (retirement, benefits, meaningful work) and seek flexibility for exceptions. Provide salary data from sources like Lightcast, Healthcare Information and Management Systems Society, American Health Information Management Association, or surveys from the American Medical Informatics Association. Challenge: Limited internal public health informatics expertise. Solution: Build capacity through “train-the-trainer” models, upskilling, and leveraging partnerships with universities. Challenge: Slow civil service processes. Solution: Start early, maintain persistence, and adapt business case arguments to different decision-makers (HR, unions, leadership). See ASTHO’s Data Modernization Primer and Tactical Guides for more information, in particular: See the Tactical Guide on Building, Equipping, and Sustaining a Data Modernization Workforce for strategies for upskilling, training, recruitment, and retention of a data modernization workforce. See the Tactical Guide on Planning Data Modernization Activities for strategies to mobilize a team, conduct current state assessments, develop plans, and gain support from leadership. Challenge: Overlap with other roles (e.g., epidemiologists). Solution: Clearly define distinctions between public health informatics and other roles, then communicate role clarity to benefit morale and efficiency. Conclusion Creating a public health informatics job classification series is both a strategic investment and a practical necessity. By distinguishing informatics as a professional path within public health, states and territories can strengthen their workforce, address long-standing recruitment and retention barriers, and prepare for the rapidly evolving demands of data modernization. While the process requires persistence, clear documentation, and negotiation across HR and leadership, the payoff is a resilient workforce equipped to manage the data infrastructure that underpins modern public health practice. Reference the How-To Guide for more details on creating public health informatics job classification series. Learn More - Brief - Creating an Informatics Job Classification Series OE22-2203 PHIG article yes

Learn how to build a business case for data modernization efforts to translate technical needs into impact-driven narratives.

Use Partner Mapping to Power Data Modernization Projects Allen Rakotoniaina, Heidi Westermann, Elyssa Stoops, Charlie Ishikawa Learn how to use partner mapping to clarify and understand your data modernization partners, and tailor engagement strategies for shared projects ownership. Partner mapping is a practical way for state, territorial, local, and tribal public health agencies to identify, organize, and engage the wide range of stakeholders involved in data modernization (DM). This resource helps agencies clarify who their DM partners are, understand their perspectives, and tailor engagement strategies to build shared ownership of DM projects. article yes

This guide provides tools and strategies to support individuals struggling to access their prescription medications.

Learn how you can prepare your staff for leadership roles through succession planning in this brief.

Learn how state public health programs like Title V can help sustain community engagement infrastructure.

Strategies and Innovations to Address Long COVID Strategies to Address Long COVID Alyssa Boyea Learn innovative strategies to address Long COVID, with examples from the field. Long COVID, or post-COVID condition, is a chronic condition that occurs after SARS-CoV-2 infection and afflicts approximately 20 million people in the United States. It is a multifaceted disease with symptoms or health problems lasting for at least three months as a continuous, relapsing, remitting, or progressive disease state affecting one or more organ systems. In 2024, the National Academies of Sciences, Engineering, and Medicine released a report defining Long COVID to harmonize terminology and measurement approaches. Long COVID has far-reaching implications beyond individual health, affecting health care systems and broader societal structures. Global economic impact of Long COVID is estimated to be approximately $1 trillion per year, including medical costs, productivity losses, and other compounding effects. Ongoing prevention efforts for Long COVID rely upon vaccination and primary prevention strategies for COVID-19 infection. The lasting impact of Long COVID requires unique health policy approaches, sustained research funding, and coordinated health and public health action to support affected individuals and mitigate long-term societal costs.  Key Challenges Diagnostics: There is no laboratory test for diagnosis nor standardized clinical diagnostic test. As a result, clinical clarity in diagnosis remains challenging. Reduced testing for acute COVID-19 infection has also hindered diagnosis and public health disease surveillance of Long COVID. Engagement: COVID-19 pandemic fatigue and reduction in trust can make it challenging to establish a trusted public health response to support impacted communities. Information is constantly evolving as more is learned about the condition, which can lead to confusion and misinformation. There is also little real-time data on community needs related to Long COVID to help tailor messaging or provide effective education. Funding: Many jurisdictions do not have dedicated Long COVID funding and are grappling with cuts to federal and state funding for Long COVID. Without sustained funding, it is challenging to retain dedicated staff — increasing reliance on part-time personnel — and continue initiatives. Jurisdiction Highlights: Advancing Long COVID Efforts Colorado In 2022, the Colorado General Assembly passed HB22-1401, directing the Office of Saving People Money on Health Care (OSPMHC) to examine and make policy recommendations that address the impacts of post-viral illness resulting from COVID-19, and directing the office to support efforts improving public health outcomes in the state. OSPMHC releases annual reports summarizing Long COVID impacts in Colorado, as well as key activities and accomplishments. Key statewide activities include developing surveys to assess socioeconomic impacts of Long COVID in Colorado, conducting a modeling study to examine factors and utilization patterns pre- and post-Long COVID diagnosis, and launching an initiative to better understand the association between clinical events prior to death and the designation of Long COVID on death certificates. Additionally, a Colorado Long COVID Community of Practice was established to discuss recent developments, share lessons learned, and inform strategies for surveillance and care, plus web/social media content to raise awareness. Minnesota The Minnesota Department of Health (MDH) launched the Long COVID program in 2021 to increase awareness and monitor potential long-term health issues following COVID-19 infection. In 2023, MDH secured state funding to expand the program and offer grants to organizations that support communities disproportionately impacted by COVID-19. Key initiatives include raising awareness about Long COVID and other infectious-associated chronic conditions (IACCs) through presentations, social media, and online resources; engaging individuals affected by Long COVID and conditions like myalgic encephalomyelitis/chronic fatigue syndrome; conducting epidemiological surveys and studies; forming a Long COVID Provider Guiding Council to foster collaboration, education, and system improvements among health care providers; and establishing the Long COVID Community Voices partner group, which led to a statewide network of organizations addressing Long COVID needs. Additionally, MDH has started a steering team of professionals and people with lived experience to guide the development of an actionable statewide framework for addressing IACCs and identify opportunities for cross-sector collaboration. New York City The New York City Department of Health and Mental Hygiene has focused its efforts on raising awareness and community engagement around Long COVID. Key activities include multilingual trainings for community and faith-based organizations and other partners to incorporate Long COVID information into their messaging with their respective communities, a study to assess long-term impacts of COVID-19 on New Yorkers, a three-part messaging campaign to share lived experience and stories of those living with Long COVID, and web/social media content to raise general awareness. Key Considerations Utilize public health resources such as the 10 Essential Public Health Services framework, “The Role of U.S. Public Health Agencies in Addressing Long COVID” and the health+ “Long COVID Human-Centered Design Report” to guide implementation of robust programs for Long COVID and related conditions. Share information on health agency websites, newsletters, or other forums to help raise awareness. Access to relevant information and resources is critical. Foster relationships and trust with various partners (e.g., health care, community-based organizations, and patient and caregiver communities) to learn about challenges/needs related to Long COVID and opportunities for collaboration. Collaborate with trusted messengers, such as community health workers and champions, to share community specific and linguistically appropriate information. Focus outreach efforts on under-resourced populations through culturally responsive frameworks. Partner with clinicians and health care systems to support clinical education and share relevant patient-focused resources for Long COVID and associated conditions. Promote sustained investment and support for Long COVID policies and research. Engage with key partners including health agency leadership, governor’s offices, state legislators, and advocacy groups to raise support for initiatives. Utilize local data and stories to show impact and advocate for dedicated resources. Long COVID Community of Practice article yes

Learn how states are improving data collection and analysis to build more robust public health programs in this brief.

Learn how education and health agencies can work together to address adolescent health through school-based programs.

Best Practices for Sustained Community Engagement Learned from the STRETCH 2.0 Midpoint Best Practices for Sustained Community Engagement from STRETCH Jessica Fepelstein The brief reflects on critical takeaways and key insights from a community health and health equity program. Creating systemic change within state public health agencies while simultaneously curating authentic, sustainable relationships with community partners can be challenging. Whether it’s issues with sustainable funding, conflicting priorities, or the toll of undertaking transformative work, making progress in these areas are often slow-moving. To assist state agencies with this work, the Strategies to Repair Equity and Transform Community Health (STRETCH) Initiative was born. Funded by the Robert Wood Johnson Foundation, STRETCH is a co-creation between ASTHO, the CDC Foundation, and the Michigan Public Health Institute focused on building lasting, systemic change to advance equity in all sectors of public health. The first iteration of STRETCH was from October 2021 through May 2023, with STRETCH 2.0 launching in January 2024 and going through May 2025. During STRETCH 1.0, its creators learned that community partners not only needed to be more involved in assisting state public health agencies in setting their equity priorities, but also needed to be leading this work in step with agency staff and leadership at the onset of decision-making conversations. Therefore, in STRETCH 2.0, community-based organizations became the project's primary applicants and fiduciary recipients, creating a state collaborative with public health agency staff. Collaboratives from seven states comprise the STRETCH 2.0 cohort, who receive technical assistance and support via personalized core response teams and engage in peer-to-peer learning through monthly practical application workshops. Creating this level of learning and sharing among states was another key lesson learned by the STRETCH partners; those working in health equity and systems change are hungry for connection with their peers. These connections not only allow staff to share best practices and common pain points, but also allow them to lean on each other emotionally and create a space of psychological safety in this sometimes-taxing work. This lesson has been operationalized with the creation of the STRETCH Network of Health Equity Practitioners virtual community. This community is open to anyone in the health equity and/or systems change public health ecosystem who would like to connect with fellow practitioners, participate in monthly “Speak and Share” discussions, and receive additional materials and best practices from across the country. Also open to the public are the STRETCH 2.0 national convenings, quarterly virtual events aimed to disseminate STRETCH lessons and create a connected network of systems change practitioners. These national touchpoints aim to expand the reach of the STRETCH initiative beyond the cohort and allow all state public health agencies to better operationalize health equity and move towards lasting, systemic change. Midway through the second iteration of STRETCH, there are already key themes and critical takeaways the partners have observed while working with the cohort of state collaboratives. Among them is ensuring community voice is always front and center in all state public health initiatives, even internal operations. Secondly, valuing the lived experiences of community members and their organizations—particularly with financial incentives—is a critical component in ensuring capacity for this valuable work. Finally, while having a plan is beneficial, the ability to be flexible and meet the needs of the collaboratives as they shift is a critical aspect of success when working on multi-sector initiatives. Key Takeaways: Lessons Learned Midway through the STRETCH 2.0 Cohort With Us, Not for Us Centering community voice is not a novel concept in community engagement and health equity efforts. One of the best practices the STRETCH initiative has found in centering community voice is allowing each state collaborative to set the purpose and agenda for their core response team’s site visit. One participant from South Carolina expressed that this model of having “on the ground” partners in charge of planning the visit was a key success of the experience and recommended continuing the use of this model moving forward. On a micro-level, this is an example of the importance of centering the community’s voice and allowing those with lived experience to lead the work. Along with systemic change, this focus on community leading the work is a central tenant of the STRETCH Initiative. Time is Money Another common theme in health equity work is the lack of sustainable funding to achieve systemic change, specifically when working directly with community partners and nonprofit organizations. To reduce the financial burden of participating in STRETCH, the second iteration of the project offered funding directly to the applying community-based organization to assist in strengthening the organization’s capacity to fully engage with this work right at the beginning. Providing a financial investment for the project not only allowed organizations to dedicate time, staff, and resources to the work of STRETCH, but it also “walked the walk” in terms of valuing community members' lived experience and expertise. While strengthening community compensation guidelines and initiatives is not novel to the STRETCH project, it is a key component of the success of the second iteration. Flexibility is Critical While the STRETCH partners did plenty of planning when developing the program’s activities, a critical theme of the initiative has been learning to meet each state collaborative’s unique and ever-changing needs throughout their participation. Whether it was leadership changes, hurricane responses, or shifts in staffing capacity, each state was faced with its own unique needs and challenges over the first half of STRETCH 2.0. A key lesson learned from the project is understanding how to alter plans and meet the states where they are with what they need, rather than focus on creating a uniform experience. In practice, this has taken shape by turning check-in meetings into working sessions, providing virtual and in-person options for relationship-building activities, and staggering site visits throughout the project year based on the priorities of each state. By remaining flexible and working in step with state collaboratives to best meet their needs, the STRETCH project has continued to be valuable to all cohort members. Want to learn more about the STRETCH project and other work of ASTHO’s Programmatic Health Initiatives and Strategies team? Check out the STRETCH framework microlearning course, our website, or email the team. article yes

Communicating About Disease Forecasting Effectively Communicating About Disease Forecasting Clearly communicating about disease forecasting helps policymakers, the media, and the public make informed decisions in public health emergencies. Communicating effectively about disease forecasting data is essential for the public to understand the associated risks, implications, and recommended actions. It’s also critical for policymakers who can use the data to determine effective, equitable strategies for outbreak response. In turn, the public can make informed decisions to keep safe. Each audience, including the media, will likely need tailored messages about the indications and limitations of a given forecast. Approaches for communicating about disease forecasts/models with policymakers and the public align with many of the key tenets of public health communications more broadly. Public health practitioners should consider integrating Crisis and Emergency Risk Communication (CERC) principles, which suggest that communications be first, right, credible, empathetic, actionable, and respectful to help the public make informed decisions during challenging circumstances. Communicating with Policymakers Policymakers—public health or elected—have important decision-making and rule-making authority; additional considerations may be needed when communicating with them about disease forecasting. Interactions frequently occur through staffers, who may have limited knowledge and/or time. In addition to CERC principles, communications should also be: Relevant. Tailor communications to policymakers’ priorities to emphasize potential impacts on resource allocation, public health outcomes, local or regional policies, and public sentiment. Collaborative. Foster relationships with policymakers and offer subject matter expertise on forecasting to inform policy decisions. Timely. Provide frequent updates, allowing for proactive collaboration, decision-making, and communication with the public. Concise. Develop briefs that summarize forecasts and their implications for constituents. Consistent. Build trust with policymakers and their staff between emergencies to highlight disease forecasting as a useful tool whose methodologies, data sources, and limitations are clear. Communicating with the Public In addition to CERC principles and in collaboration with media partners, communication about disease forecasts/models with the public should be: Accessible. Provide easily accessed information about methodology, data sources, and limitations in the forecasts. Clear. Use jargon-free, non-technical language to convey critical messages. Contextualized. Frame forecasts within the broader public health context, emphasizing how individual and community actions can mitigate risk, and reinforce the effects of collective actions as part of an outbreak response. Empowering. Give the public reasonable, actionable steps to protect themselves and their communities. Local. Use social media, news releases, listening sessions, and other relevant means to reach as broad an audience as possible. Collaborate with community leaders and health care providers to amplify messaging and reduce misinformation. Frequent. Keep the public informed with regular updates on forecast products including changes in local risk levels, new trends, guidance, and recommendations. Utah’s Best Practices for Communicating Forecasts During the COVID-19 response, the Utah Department of Health and Human Services (DHHS) modeled potential disease transmission and shared how to effectively communicate with the media and public. DO Create diverse forecasting and communications teams that include public health, universities, and ‘bonus’ team members (e.g., political representatives, laboratories, and health economists). Clarify the purpose for which a given model was developed. Discuss the limitations of the disease model. Communicate about future outcomes (i.e., what would happen without further intervention). Provide language on how to alter the current path (e.g., ‘With this intervention, we could potentially avoid…’) Remind audiences that models can affect the future, not only predict it. Share information and data that are digestible for the public. DON’T Sound definitive when outcomes aren’t clear or make predictions using absolute terms. Omit a variety of scenarios or tools when presenting a forecast. Disregard inherent uncertainties in forecasts. Show models with conflicting results. Utah DHHS also recognized that members of the media are key partners in communicating public health messages; closely coordinating and contextualizing forecasts helps communicate accurate conclusions and/or recommendations. Communicators and staff should be prepared and have information ready to share for more complex questions as needed. Storytelling with forecasts and models helps the reader internalize them and make informed decisions. CDC-RFA-OT18-1802 2018-2024 article yes

Fairfax County Health Department Modernizes Infrastructure to Optimize Public Health Data Sharing Susan Fluerant, Reema Mistry, Christina Severin Learn how the Fairfax County Health Department in Virginia is working to modernize its data infrastructure & optimize public health data sharing. Using lessons learned from the COVID-19 pandemic, the Fairfax County Health Department (FCHD) is coordinating with county agencies, the Virginia Department of Health (VDH), and nonprofit public health organizations to modernize its data infrastructure and optimize public health data sharing functions. FCHD’s Informatics and IT team engaged in a strategic process to develop a multiyear IT roadmap, which outlines solutions and systems required to support this modernization, including clinical services, communicable disease surveillance, laboratory information systems, communication systems, and solutions for community engagement and administrative needs. As a result, FCHD is well-positioned to leverage its robust IT and data infrastructure to align with VDH for better data sharing. Advancing IT and Informatics Infrastructure Challenges associated with manual data-sharing processes (e.g., the use of CSV files to ingest data and produce analyses) during the COVID-19 pandemic prompted FCHD to reassess its informatics capacity. It conducted department-wide needs assessments and identified the need for improved technology, increased workforce capacity, and better data governance policies. It then ascertained IT functions that could be outsourced (e.g., cloud-hosted solutions and managed services for FHIR HL7 implementation) versus core public health functions (e.g., manipulating and managing data for epidemiologic use) that needed to remain internal, allowing FCHD to preserve internal staff capacity for key public health activities. Public health staff found working with CSV files to be inefficient for large or frequently updated datasets. To address this challenge, FCHD worked closely with VDH and the Fairfax County Informatics and IT team to adopt automated processes and develop a data warehouse solution—allowing FCHD to manage and transform data from multiple sources as well as control the frequency and timing of data retrieval, enhancing their ability to respond promptly to public health needs while keeping data secure on cloud-host servers. VDH hosted an API for FCHD to retrieve death data, significantly increasing flexibility and reducing the need for manual intervention. As FCHD increases the use of new data sources and technology, it continues to develop data governance policies, roles/responsibilities for data users, and data safeguarding guidance. Noel Clarin - Brief - Fairfax VA DMI to Optimize Public Health Data Sharing Engaging State and Local Partners FCHD recognizes that data sharing agreements are vital to support data exchange and, until recently, relied on informal data sharing agreements among other jurisdictions in Virginia. It partnered with attorneys at the state and local levels to work toward a universal data sharing agreement, which can expedite the data sharing process when public health programs have new use cases for local data. As a result, FCHD executed a Memorandum of Understanding with VDH in less than six months—a notable improvement from past data sharing agreements, which historically could take over a year to execute. They worked collaboratively through complex technical and bureaucratic challenges, highlighting the iterative nature of establishing effective data sharing protocols. FCHD also supported relationship-building between programs and divisions within the Fairfax County government, allowing for greater strategic alignment around emerging technologies. Interdepartmental relationship-building between public health program staff and the Fairfax County IT team has been equally important to foster effective collaboration and identify data modernization champions within FCHD. Alida Laney - Brief - Fairfax VA DMI to Optimize Public Health Data Sharing Planning for Sustainable and Diverse Funding Sources FCHD received an initial grant from the Public Health FHIR Implementation Collaborative through NACCHO, which helped launch the IT infrastructure improvement work; however, one-time funding is not a long-term solution. Now, FCHD is developing a long-term funding strategy to support the costs of IT systems licensing, operations and maintenance, and research and development. FCHD recognizes as public health changes, so must the technology that supports it, and modernization will require sustainable funding from government, associations, and other sources. Centering Health Equity in Informatics Solutions FCHD is developing processes to collect and standardize data disaggregated by sexual orientation and gender identity, race and ethnicity, language, and the social determinants of health to better identify and address health disparities. By incorporating additional data into its systems, program staff can now make informed decisions to strengthen health literacy by disseminating information in preferred languages and easy-to-read formats, and ensuring materials are accessible to persons with colorblindness. Ben Klekamp - Brief - Fairfax VA DMI to Optimize Public Health Data Sharing(2) Implementation Considerations Foster relationships within and across local and state government to get buy-in for the modernization of public health informatics infrastructure and the improvement of data-sharing practices. Define clear goals for implementing new technology, and build a strategy for infrastructure improvement, partner engagement, and long-term sustainability that’s grounded in a shared understanding of the goals. Align workforce responsibilities, process improvement efforts, and technological advancements. Develop universal data sharing agreement templates between state and local health departments to expedite future data-sharing efforts. OT18-1802 website yes

Strengthening Grant Management Functions in Puerto Rico ASTHO | Toolkit helps to optimize grant activities and funds in Puerto Rico The Grants Management Office Structure Optimization Toolkit helps to assess a health department's federal grant workload, staffing requirements in its grant management office, and potential to optimize grant management activities. The Puerto Rico Department of Health (PRDOH) is using it as a guide for improving internal grants management capacity and oversight to maximize federal funding outcomes. PRDOH anticipates increased information flow, a more inclusive culture, and additional benefits. Get the Infographic in English (PDF) Obtén la infografía en español (PDF) website yes